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PA Catheter Over-Wedging — FRCA Final MCQ

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HardIntensive Care MedicinePA Catheter Over-WedgingFRCA Final

A 55-year-old man on the ICU has a suspected pulmonary artery catheter (PAC) complication. The PA pressure trace suddenly shows a dampened waveform with elevated diastolic pressure matching the wedge pressure. What has happened?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Catheter has migrated distally causing persistent wedging (over-wedging)

A dampened PA waveform with diastolic pressure matching PCWP suggests the catheter has migrated distally and become persistently wedged in a smaller PA branch (over-wedging). This is dangerous: the balloon is not inflated but the catheter tip is occluding a vessel, risking pulmonary infarction and PA rupture. Management: immediately withdraw the catheter 2-3 cm (with balloon deflated) until a normal PA waveform returns. Check CXR for catheter position. PA rupture from over-wedging or balloon inflation in a distal branch is a potentially fatal complication of PACs.

Reference: RCOA – 2023 – Haemodynamic monitoring: PA catheter complications